INDIRECT OPHTHALMOSCOPY
HISTORY
Introduced in 1861 by
M.A.L.F Giraud Teulon.
ALLVOR GULLSTRAND
Swedish
Ophthalmologist
First reflex free
Ophthalmoscope(
along with Thorner).
Nobel Prize 1911 for
work on optics of eye.
PRINCIPLE
Works on the same principle as
ASTRONOMICAL TELESCOPE
Patients cornea and crystalline
lensobjective lens of the astronomical
telescope
Condensing lenseye piece of the
astronomical telescope
The eye is made highly myopic by placing the
convex lens in front of the patients eye
Emergent rays from an area of the fundus form
a REAL INVERTED IMAGE between the lens and
the observers eye.
ADVANTAGES
1. Large field of view:
Encompassing an area equal to about 30
degrees of ocular fundus.
5 to 6 DD in each direction.
When coupled with pupillary dilatation and
eye movement, the ocular fundus can be
assessed from vitreous base to vitreous base.
2. Binocularity:
High degree of stereopsis is achieved with BIO.
3. To view hazy media because of its bright light
and optical property.
DISADVANTAGES
1. Not easily mastered and difficult with small
pupils.
2. Magnification lesser compared to direct
ophthalmoscopy
3. Fundus image is inverted and reversed.
Hence requires interpretation.
Illumination of the fundus
Intense source of light
through the pupil.
Fundus image
projected out by
patients own refractive
power
Emmetropic eye would project the image to
infinity
By using a condensing lens (e.g.:+20D),a new
image is created at its secondary focal plane.ie
5 cm in front of the lens.
This image is called the AERIAL IMAGE
Maintaining conjugacy of pupil
The pupils of the examiner and the patient
must be optically conjugate
Then, maximal amount of light passes from the
patient fundus into the observer's eye.
BINOCULAR OBSERVATION
To appreciate the aerial image 3
dimensionally, both of the observers pupils
must receive light from the aerial image.
For this, observers pupils must be imaged with
the patients pupil.
the observers interpupillary distance is
reduced via mirrors.
Illumination source
Condensing lens-
it projects retinal image & image of
illumination source.
To prevent glare- area of patients pupil not
occupied by outgoing light selected.
Hold C.L. at a distance equal to focal length
from anterior focus of eye. Also tilting of lens
helps.
Prerequisites for INDIRECT
OPHTHALMOSCOPY
Dark room
Convex lens
Subjects pupils should
be dilated
Indirect
ophthalmoscope
PROCEDURE
1. Procedure is explained to the patient and pt
is made to lie supine, and instructed to keep
both eyes open.
2. Examiner throws light into the patients
pupilfrom an arms distance
3. Binocular ophthalmoscope with headband is
most frequently used.
4. Condensing lens is placed in the path of beam
of light to view the retinal image.
5.It is held parellel to the iris plane
6. The examiner moves around the head of the
patientto examine different quadrants
7.By asking the patient to look in extreme gaze
and with the help of a scleral indenter, the
whole retina is examined.
SCLERAL INDENTATION
Done with the
depressor placed on
patients lids.
It elevates the retina
hence allowing it to be
examined in profile.
Scleral depressor is moved in a direction
opposite to that in which depression is
desired.
Should be rolled gently and tangentially over
the eye surfaces
Clinical indications for S.I
1. To assess recent ocular or head trauma cases.
2. To enhance recognition of retinal break.
3. To determine thickness of retinal break
4. To r/o retinal break or detachment in a
patient with entoptic symptoms
5. To evaluate the presence of fluid surrounding
a retinal break.
6. To evaluate the presence of vitreous traction
surrounding a retinal break.
Fundus drawing
Vertically inverted &
laterally reversed
Top of chart placed
towards patients feet
(upside down)
Thus inverted position
of chart in relation to
patients eye
corresponds to inverted
image of fundus
Optic disc-red margins
Retinal veins-blue.
Arteries not drawn
Attached retina-Red
Detached retina blue
Retinal breaks-red with blue outlines
Flap of retinal tear-blue
Thin retina- red hatchings outlined in blue
Lattice degeneration-blue hatchings outlined
in blue
Retinal pigment black
Retinal exudates-Yellow
Vitreous opacities - green
REFERENCES
BORISH-OPTICS.
AAO
KANSKI
OPTICS- KHURANA
E-OPTHAL.
INTERNET
